I am only 32 and have been diagnosed with DD. I know that there is a limit to the number of suguries one can have but how many NA treatments can one have before it becomes impossible or not work any longer? Since recurrance with NA is more frequent I would imagine this is something that should be considered. Also has anyone had surgury after NA or does NA make surgury not a viable option down the road? Thanks

Dear Steve,

There is a list of trained practitioners at www.dupuytrens.org. Dr. Eaton (Florida) and Dr. Spacek (Montreal) are the only two North American doctors who appear on that list.

Frances

Hammer,

Eaton was very clear in stating that in some cases there is an outside limit to the use of NA. While in France, he saw cases where NA had just about run it's course. Over many releases in the same aria, the cord can eventually become more and more diffuse, rendering NA powerless. It is at this point that the patient must resort to OS.

How many tines? I don't know. Is OS now made more difficult? Not necessarily. It will remove all the tissue, diffuse or not. So, in very aggressive cases, NA is just buying time over many years before OS must finally be done. Now, in such cases, OS would presumably have recurred as well, and with far less forgiveness and a hard limit of 3 or 4 procedures.

So if it were me, I'd milk NA as long as I could, then ride the blade until the end of the line. If you have a raging case that will most likely cripple you in the end, a case can be made that starting with NA may well extend the life of the hand(s) far more than starting with OS. Naturally, someone like Dr. Press would have a clearer understanding as he does both NA and OS.

This is the scenario where Collegenase might be of great value. Is there any reason it couldn't be used to dissolve diffuse Dups tissue?

The definitive data comparing NA to OS in terms of recurrence will not begin to emerge for another 4 to 5 years. We just don't know at this point.

Kristen:

I'm just reporting what Eaton said that he saw in one case in Paris. You might let us know the opinion and experience of whoever does you next procedure.

Steve - I was diagnosed about 4 and half years ago - went from a lump in my right palm to a stage 1 ring finger problem in only 6 months. On my right hand, both the ring finger and pinky are affected - unfortunately, a lot of the growth is in the fingers and not in the palm. My left hand problem started about 3 years ago - lumps in the palm now and a severely affected pinky - 100 degrees and getting worse. For the first few years, I would get NA on my pinky, but as time went on, the results lasted less than 6 weeks, so I gave up on it. The PIP joint is frozen. I only get NA on my right hand now. I've been to Dr. Eaton twice in the last year (he's only 40 miles away), though in the past I've been to doctors Badois, Lellouche and Lermusiaux.

I had scheduled surgery 3 weeks ago with Dr. Zidel (Eaton's colleague). The plan was to fuse the PIP joint of my left pinky at 45 degrees to make it less of a pain in the neck. However, whether it was his intention or not, Dr. Zidel talked me out of it - scared the crap out of me with a very long discussion of possible severe complications, such as RSD (reflex sympathetic dystrophy - google it, you don't want it!) and dupuytren's flare. He felt that I had a higher than average risk of such complications, not to mention that the size of my hands (small) provided a further challenge for a successful fusion. At this point I'm "living with it." In the meantime, my right hand is still responding well to repeated NA. How I'll keep my hands working for another 30 years I haven't a clue - on the up side, I'm not in pain. Hope this info is useful Kristen